AAP Voices Blog

Training to Care for Pediatric Patients 

With more than 13 years of experience as a pediatric emergency physician, I have cared for numerous sick and injured children.  Many of the patients made full recoveries, some survived with lasting disabilities, and some of these patients died. Were it not for the specialized pediatric training our prehospital providers receive and their confidence in using this knowledge, more patients might have faced dire outcomes. 

Nationally, less than 10 percent of all emergency medical services calls involve pediatrics. In rural areas, where most emergency personnel are volunteers, the number is even lower. Since children represent a small fraction of their overall calls, most prehospital providers experience anxiety when treating and transporting pediatric patients, especially the younger ones. Fortunately, the American Academy of Pediatrics (AAP) has developed educational curricula to enhance prehospital provider training, the Pediatric Education for Prehospital Professionals (PEPP) program – now celebrating 25 years of providing pediatric education to prehospital providers.    

In the PEPP curriculum, prehospital professionals are taught how to evaluate pediatric patients.  This evaluation is often difficult for various reasons including communication, size, and dosing. Infants, toddlers, and children with special needs who are unable to communicate verbally rely on vital signs and general appearance to convey their discomfort. Prehospital professionals are also educated on how to accurately dose and administer medications and about disease processes unique to pediatric patients. They are taught how to select the appropriate airway equipment for patients requiring airway maintenance and the proper use of other pediatric equipment.  

As children grow and change emotionally and intellectually, their anatomy and physiology also change dramatically. It is important that paramedics are aware of physical traits that make children’s bodies different from adults. Children are not merely “little adults” and should not be medically treated as such. With PEPP education, trained prehospital providers gain an understanding of how anatomy changes and disease processes develop as patients grow older. This understanding allows them to make necessary adjustments to improve airway management, select appropriately sized equipment, communicate with, and perform a thorough evaluation for all ages.  

I had a 12-year-old boy brought into the ED after falling through the ice and being submerged for an unknown amount of time. The family called 911 and when emergency medical workers pulled the patient from the water, he had no pulse, and he was cold. The paramedics initiated CPR and began actively warming the patient.  Thanks to their PEPP knowledge in hypothermia injuries, the paramedics helped the boy regain a detectable pulse. The patient was brought into the emergency department with a strong heartbeat and normal blood pressure. He was intubated, and ultimately made a full recovery, partly due to the initial treatment the paramedics provided.   

“Children are not merely ‘little adults’ and should not be medically treated as such. With PEPP education, trained prehospital providers gain an understanding of how anatomy changes and disease processes develop as patients grow older.” 

Although there are serious and somber cases in the emergency department, I also have memories of laughing with prehospital providers. My team vividly recalls the time we treated a 4-year-old patient who choked on a piece of candy. The patient maintained his oxygenation but was in distress. Once we transported the patient to a bed in the emergency department, he vomited the piece of candy and exclaimed, “Wow, I feel better now…Mom can I eat that?” We all looked at each other, started to laugh, then broke the news to him that it’s probably best not to eat it. The team did everything right to prepare for an airway emergency, and this time we had a good outcome.   

We must also provide training for the times when patients arrive in full arrest due to trauma or illness, and despite all the medications administered and CPR efforts made, ultimately do not survive. These times are extremely tough. As a medical director, I make every effort to debrief with the team and provide feedback, encouragement, and education. This helps us continue to improve and do what’s needed for every child.  

One of my mentors, a paramedic, told me a long time ago, “[Children] will get sick or injured and some will die, but someone has to care for them, and I can be the one who makes a difference.” I continue to share this truth with prehospital providers. We all know that taking care of pediatric patients starts with having a heart for children, but it continues with education and training. PEPP provides that education and training, but prehospital professionals offer the heart and compassion.  

Pediatricians and prehospital providers alike want children to have the best possible outcomes when emergencies occur. For the past 25 years, PEPP has helped prehospital providers prepare for pediatric emergencies. Please recognize the life-saving potential of this program and recommend it to someone you know who needs it. Visit peppsite.com to learn more about PEPP, including finding a nearby course and how to become a PEPP instructor.